Monday, December 1, 2008

Next up: a chat with the oncologist

The barium sulfate is still rumbling through my gut more than a couple of hours after my follow-up CT scan. Lord knows where the iodine contrast has gone. And then there’s the radiation dose to consider. There’s a tradeoff between the risks of x-ray exposure—which cumulatively can cause cancer itself—and the hunt for recurrent melanoma. For now, I’m willing to err on the side of loading up on ionizing radiation. I’m also really eager to see radiologists remain fully employed.

This is my first scan post-interferon, so of course I’m a little nervous. I should hear results from my oncologist today or tomorrow. Melanoma is a tricky bastard in that while my prospects of long-term survival improve with each clear report, there is always a chance of relapse. My friend Tom went 14 years between his episodes. One of those lovely sayings that you hear in oncology circles is “Once a cancer patient, always a cancer patient.” If you’re looking for a business model that guarantees an endless revenue stream, try the cancer-industrial complex.

I have an appointment in two weeks with the melanoma specialist in Portland who I saw last summer. My main objective is to ask his opinion on follow-up surveillance. There appears to be no standard of care for imaging tests on melanoma survivors. Some docs, including my surgeon at OHSU, advise PET/CT at regular intervals, and others promote watchful waiting: if you don’t have symptoms, don’t sweat it. My doc splits the difference and recommends quarterly CTs. The “no scan” approach has its appeal, in that overall survival statistics don’t vary much, regardless of the medical care you receive post-surgery. It would also end this tedium of living life in three-month increments.

My frame of mind is actually pretty good. The shock and awe of the previous diagnosis has worn off, and I’m mostly at peace about my life. I have so much for which to be grateful. The last couple of months compared to the previous eight have been wonderful. My head is clear, my body strong, and my soul at rest. I hope I can make the same statement so boldly after my next chat with the oncologist.

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